Objective: A comprehensive quantitative summary of the efficacy and acceptability of psychological interventions (PIs) for adult posttraumatic stress disorder (PTSD) is lacking. Method: We conducted a systematic literature search to identify randomized controlled trials (RCTs) examining the efficacy and acceptability (allcause dropout) of psychological interventions (i.e., trauma-focused cognitive behavior therapy [TF-CBT], eye movement desensitization and reprocessing [EMDR], other trauma-focused interventions and non-traumafocused interventions). Results: One hundred fifty-seven RCTs were included comprising 11,565 patients. Most research (64% of RCTs) accumulated for TF-CBT. In network meta-analyses, all therapies were effective when compared to control conditions. Interventions did not differ significantly in their efficacy. Yet, TF-CBT yielded higher short-(g = 0.17, 95% CI [0.03-0.31], number of comparisons kes = 190), mid-(i.e., ≤5 months posttreatment, g = 0.23, 95% CI [0.06-0.40], kes = 73) and long-term efficacy (i.e., >5 months posttreatment, g = 0.20, 95% CI [0.04-0.35], kes = 41) than non-trauma-focused interventions. There was some evidence of network inconsistencies, and heterogeneity in outcomes was large. In pairwise meta-analysis, slightly more patients dropped out from TF-CBT than non-trauma-focused interventions (RR = 1.36; 95% CI [1.08-1.70], kes = 22). Other than that, interventions did not differ in their acceptability. Conclusions: Interventions with and without trauma focus are effective and acceptable in the treatment of PTSD. While TF-CBT yields the highest efficacy, slightly more patients discontinued TF-CBT than non-trauma-focused interventions. Altogether, the present results align with results of most previous quantitative reviews. Yet, results need to be interpreted with caution in light of some network inconsistencies and high heterogeneity in outcomes. What is the public health significance of this article?The present summary of the available evidence illustrates that several psychological interventions for PTSD in adulthood are effective and acceptable. While trauma-focused cognitive behavior therapy (TF-CBT) yields the largest treatment effects, slightly more people decide to discontinue TF-CBT than psychological interventions without a trauma focus.

While dozens of randomized controlled trials (RCTs) have examined psychological interventions for adult posttraumatic stress disorder (PTSD), no network meta-analysis has comprehensively integrated their results for all interventions and both short and long-term efficacy. We conducted systematic searches in bibliographical databases to identify RCTs comparing the efficacy (standardized mean differences in PTSD severity, SMDs) and acceptability (relative risk of all-cause dropout, RR) of trauma-focused cognitive behaviour therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), other trauma-focused psychological interventions (other-TF-PIs) and non-trauma-focused psychological interventions (non-TF-PIs) compared to each other or to passive or active control conditions. Hundred-fifty RCTs met inclusion criteria comprising 11,282, 4,443 and 3,167 patients at post-treatment assessment, ≤ 5 months follow-up and > 5 months follow-up, respectively. By far the most data exist for TF-CBT. We performed random effects network meta-analyses (efficacy) and pairwise meta-analyses (acceptability). All therapies produced large effects compared to passive control conditions (SMDs ≥ 0.80) at post-treatment. Compared to active control conditions, TF-CBT and EMDR were moderately more effective (SMDs ≥ 0.50 < 0.80), and other-TF-PIs and non-TF-PIs were slightly more effective (SMDs ≥ 0.20 < 0.50). Interventions did not differ in their short-term efficacy, yet TF-CBT was more effective than non-TF-PIs (SMD = 0.14). Results remained robust in sensitivity and outlier-adjusted analyses. Similar results were found for long-term efficacy. Interventions also did not differ in terms of their acceptability, except for TF-CBT being associated with a slightly increased risk of dropout compared to non-TF-PIs (RR=1.34; 95% CI: 1.05-1.70). Interventions with and without trauma focus appear effective and acceptable in the treatment of adult PTSD with most certainty for TF-CBT, which, however, appears somewhat less acceptable than non-TF-PIs.